Coronary Atherosclerosis in Former NFL Players

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Subclinical coronary artery disease in former National Football League players (n=3). Intervention: Coronary computed tomography angiography (CCTA) with AI-enabled quantitative plaque and FFRct analysis (Heartflow) vs. Prior traditional noninvasive cardiovascular screening. Primary outcome: Detection and characterization of previously undiagnosed coronary artery plaque and flow-limiting stenosis.

Q: What does this research mean for the field?

Coronary computed tomography angiography with AI-enabled analysis identifies previously undiagnosed, predominantly noncalcified coronary plaque in asymptomatic former NFL players, facilitating prompt initiation of medical therapy and revascularization. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Campbell Rogers; David J. Maron; Kevin M. Young; James Kovach; John W. Farquhar; Jeffrey Boone

doi:10.1016/j.jaccas.2026.107021

March 1, 2026JACC Case ReportsOpen Access

Coronary Atherosclerosis in Former NFL Players

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Key result

AI-enabled CCTA identifies noncalcified plaque in 100% of tested former NFL players.

n=3

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Former professional athletes may be at paradoxically high cardiovascular risk, and retired National Football League players carry a high burden of atherosclerosis risk factors and elevated risk of acute cardiovascular events.

Does coronary computed tomography angiography coupled with artificial intelligence-enabled analysis detect previously undiagnosed coronary artery disease and guide preventive management in asymptomatic former NFL players?

Key Points

To evaluate whether coronary computed tomography angiography paired with artificial intelligence plaque analysis detects unrecognized coronary artery disease in asymptomatic retired National Football League players.
Examined 3 asymptomatic former National Football League players from the ongoing GAMEFILM registry (NCT06831409) who had prior negative noninvasive stress evaluations.
Conducted coronary computed tomography angiography (CCTA) combined with artificial intelligence plaque analysis and computed tomography-derived fractional flow reserve (FFR CT) assessments.
All 3 players demonstrated previously undiagnosed coronary artery plaque, with noncalcified plaque comprising 86.8% to 92.3% of total plaque volume.
Two patients had extensive disease: 1 patient (age 65) had 70%-99% stenosis, an FFR CT of 0.65 across 3 flow-limited vessels, and underwent coronary artery bypass surgery; another (age 54) had 70%-99% stenosis and an FFR CT of 0.93.
One patient (age 56) had early-stage disease with 30%-49% stenosis, an FFR CT of 0.95, and a total plaque volume of 92 mm 3, prompting guideline-directed medical therapy.

Study Design

Type

Case Report (n=3)

Structured PICO

Does coronary computed tomography angiography coupled with artificial intelligence-enabled analysis detect previously undiagnosed coronary artery disease and guide preventive management in asymptomatic former NFL players?

P

Population

3 male former NFL players (aged 54-65 years) without prior known history of coronary artery disease who previously participated in the NFL Brain and Body Screening Program.

I

Intervention

Coronary computed tomography angiography (CCTA) coupled with artificial intelligence (AI)-enabled analysis (Heartflow Inc) to assess plaque burden and fractional flow reserve derived from CT (FFR_CT)

O

Outcome

Detection and characterization of coronary artery plaque volume (total, noncalcified, and calcified), maximum stenosis severity, and lesion-specific fractional flow reserve derived from CT (FFR_CT)surrogate

CCTA coupled with AI-enabled plaque and physiological analysis can detect substantial subclinical, predominantly noncalcified coronary atherosclerosis in former NFL players missed by traditional screening, directly prompting preventive medical therapy and necessary revascularization.

Limitations

Small descriptive case series of only 3 patients
Lack of a control group or statistical comparison
Ongoing registry with no long-term clinical outcome follow-up reported

Ask about this paper

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Implication

May support AI-CCTA screening in high-risk former athletes; hypothesis-generating and requires prospective validation before practice change.

Abstract

Former professional athletes may be at paradoxically high cardiovascular risk. Retired National Football League players in particular are known to carry a high burden of atherosclerosis risk factors and to be at elevated risk of acute cardiovascular events. We present 3 cases of asymptomatic former National Football League players, each unaware of the presence of coronary artery disease despite prior noninvasive evaluation, who underwent coronary computed tomography angiography coupled with advanced artificial intelligence–enabled analysis as part of an ongoing clinical registry. All 3 former players were found to have previously undiagnosed coronary artery plaque, prompting guideline-directed medical therapy. One patient had early-stage disease burden and 2 had extensive disease, including 1 patient with multiple severe stenoses accompanied by significant physiological impairment and fractional flow reserve reduction who underwent coronary artery bypass surgery. Early patient-specific characterization of coronary artery disease via coronary computed tomography angiography and artificial intelligence–enabled analyses may enable more prompt preventive management and result in clinical risk reduction in this population.

Discussion

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Cite This Study

Rogers et al. (2026) conducted a case report in Subclinical coronary artery disease in former National Football League players (n=3). Coronary computed tomography angiography (CCTA) with AI-enabled quantitative plaque and FFRct analysis (Heartflow) vs. Prior traditional noninvasive cardiovascular screening was evaluated on Detection and characterization of previously undiagnosed coronary artery plaque and flow-limiting stenosis. CCTA with AI-enabled analysis detected previously undiagnosed coronary plaque (87%-92% noncalcified) in all 3 former NFL players (100%), prompting medical therapy and CABG in 1 patient.

synapsesocial.com/papers/69c770418bbfbc51511e0842 https://doi.org/10.1016/j.jaccas.2026.107021

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Coronary Atherosclerosis in Former NFL Players

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Coronary Atherosclerosis in Former NFL Players

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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